Ventricular Septal Rupture Research Articles

Percutaneous Coronary Intervention in Post-Infarction Ventricular Septal Rupture

Background: Ventricular septal rupture (VSR) is a fatal mechanical complication following acute myocardial infarction (AMI). The definitive treatment remains surgical repair, however several aspects are still debatable, including the timing of surgery. Patient’s refusal of treatment and lack of medical facilities put other challenges in management of VSR. Case presentation: A-48-year-old male with a history of diabetes mellitus and hypertension came with a late-presentation anterior AMI, and refused the reperfusion therapy. By the third day, he developed VSR and cardiogenic shock. The patient was also against any referral plan for further therapy. Hemodynamic status was optimally controlled with vasopressor and inotropic agents. The patient was discharged with a grade II-III New York Heart Association (NYHA) on the tenth day. In follow up evaluation a week later, the patient presented limb swelling and functional NYHA class III-IV. The patient agreed to received percutaneous coronary intervention (PCI). Drug eluting stent (DES) in left anterior descending (LAD) coronary artery was implanted successfully without defect closure. Follow-up after 12-months revealed no signs or symptoms of decompensated heart failure.
 
 Keywords: ventricular septal rupture; percutaneous coronary intervention; acute myocardial infarction

A novice’s approach to a ventricular septal rupture closure with an atrial septal device

A novice’s approach to a ventricular septal rupture closure with an atrial septal device

Increased number of ventricular septal rupture cases after acute myocardial infarction in 2020.

Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI)such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution. From a retrospective database analysis in our institution between the years 2004 and2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality. Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intra-aortic balloon pump were associated with significantly increased mortality using logistic regression. We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.

A new surgical technique for post-myocardial infarction ventricular septal rupture with hemodynamic instability.

A new surgical technique for post-myocardial infarction ventricular septal rupture with hemodynamic instability.

TCTAP C-109 Post Myocardial Infarction Ventricular Septal Rupture with Heart Failure Treated Successfully with Transcatheter Device Closure

TCTAP C-109 Post Myocardial Infarction Ventricular Septal Rupture with Heart Failure Treated Successfully with Transcatheter Device Closure

Ventricular Septal Rupture following Anterior Acute Myocardial Infarction: A Challenge to a Sub-District Physician

Background: Ventricular septal rupture (VSR) is one of the most serious mechanical complications following acute myocardial infarction (AMI). Although a rare complication, it is associated with significant mortality and morbidity. The purpose of this report was to present a case of VSR following anterior AMI in our hospital.
 Case Description: A 54-year old Javanese male presented persistent episode of breathlessness and lower limb swelling for the last two days with prior chest pain 7 days ago. Physical examination revealed a grade 3/6 holosystolic murmer loudest over the apex, S3 gallop, rales bibasally of the lung. Electrocardiographic evidence revealed for a recent anterior myocardial infarction. Chest X-Ray showed a cardiomegaly and pulmonary congestion. Transthoracic echocardiography revealed VSR at mid-anteroseptal with estimated length of 8-10 mm, preserved LVEF 51% with mid-apicoseptal akinesis. Multiple readmissions were noted for this patient in the follow-up with worsened conditions.
 Discussion: This is a challenging case report since our hospital is an incapable cath-lab sub-district hospital and far from PCI-capable center. It is critical that all patients with AMI have a brief evaluation for mechanical complications such as VSR. All patients who developed hemodynamic instability during AMI should be comprehensively examined for the murmur and any other heart sound that may provide valuable information.
 Conclusion: Every clinician especially in the low-resource setting should be aware of this potentially fatal mechanical complication as the mortality remains significantly high. Early prompt diagnosis and treatment is the key of achieving an optimal outcome.

The Triple-Layer Patch Technique for Postinfarction Ventricular Septal Rupture

Postinfarction ventricular septal rupture (VSR) represents a well-known mechanical complication of myocardial infarction, determining cardiogenic shock with high mortality rates. Surgical correction requires significant expertise to avoid cardiac rupture, uncontrollable bleeding, residual shunts, heart failure, and death. In the last year, we observed a substantial increase of VSR at our hospital, related to the delayed presentation of people with acute chest pain to the emergency departments during the coronavirus disease 2019 pandemic. We discuss our innovative triple-layer patch technique in a recent consecutive series of 8 patients. This technique proved effective in all patients, with no residual shunt or cardiac rupture.

Retrospective Analysis of Surgical Treatment Results of Postinfarction Ventricular Septal Rupture

Ventricular septal rupture (VSR) is the most dramatic complication of acute myocardial infarction (MI). It manifests itself most often in the first week after infarction, with the maximum fatal complications occurring on day 1 and day 3–5 after MI. Patients receiving conservative treatment mostly die of progressive heart failure within few hours or days. Even now, in the era of endovascular interventions, surgical treatment remains the gold standard for the treatment of this pa-thology. Our research is mainly aimed at studying the factors of operative mortality, describing our methods of treatment and analyzing the survival rate and long-term outcomes after surgical treatment of this pathology.
 We studied 90 patients with postinfarction VSR who underwent surgical intervention in 2002–2019. Twelve of them were operated at the Central Clinical Hospital in Baku, and 78 at the National Amosov Institute of Cardiovascular Surgery in Ukraine. The mean age of the patients was 59.9 ± 9.59 years, 65 (72.2%) were men and 25 (27.8 %) were women. Fifteen (16.6%) patients were smokers, 31 (34.4%) were diabetic, 70 (77.7%) patients had arterial hypertension, 62% of patients had NYHA class III heart failure with average ejection fraction of 43.9 ± 10.4%. According to the results of coronary angiography, single vessel stenosis of the coronary arteries was detected in 18 (20%), two-vessel lesion in 32 (35.5%), and three-vessel lesion in 40 (44.4%) patients. There were no patients with left main coronary artery (LMCA) stenosis.
 Long-term results of surgical treatment were followed for 1 to 8 years, on average in 18 (28.6%) patients. Within 1, 3 and 8 years 17, 12 and 2 patients were examined, respectively. Good results within 5 and 10 years after surgical treatment were observed in 87.5% and 64.3% patients, respectively.
 Repeated complaints in our group and those observed in the literature are associated with worsening of heart failure after venticulotomy and changes in the geometry of the left ventricle.
 Recurrence of heart failure and coronary symptoms within 3 years and after 3 to 8 years were observed in 6 (33.3%) and 3 (25%) patients, respectively. Repeated endovascular revascularization was performed in 5 patients. ICD was im-planted in 4 patients, and in 2 patients CRT-D was implanted within 4 years 2 months and 7 years, respectively.
 There were no hemorrhagic complications within 8 years. Four (22.2%) patients died in the long-term period, the cause of death was unknown.
 In intensive care department the treatment strategy suggested hemodynamic stabilization with the help of conserva-tive therapy and IABP.
 The patients who underwent surgery in ≥ 3 weeks after the diagnosis of postinfarction VSR survived within 30 days after surgery. Delayed planned recovery is stipulated by the formation of scar tissue in the myocardium, which enables to facilitate the technical aspects of recovery. The time of the operation depends mainly on hemodynamic status of the patient. Patients with cardiogenic shock should undergo immediate surgical treatment.

Predicting Ventricular Septal Rupture in ST-Elevation Myocardial Infarct in Low Resource Setting: a case series

Background: The mortality rate caused by myocardial infarct (MI) escalates in the presence of ventricular septal rupture (VSR). This article aimed to analyze clinical factors that might be valuable as predictors of VSR.
 Case Illustration: We found and presented six documented post-infarction VSR out of 1,613 MI cases between January 2015 to December 2019.
 Conclusion: Based on the analysis, clinicians should be aware of these factors as they were potential to be the predictors: advanced age, first MI, anterior location of the infarct, infranodal conduction disorder, no reperfusion treatment, high systolic blood pressure on admission, and no smoking history.

Emergency Surgical Repair of Post Infarction Ventricular Septal Rupture

Ventricular septal rupture (VSR) is a life-threatening complication of myocardial infarction (MI). Surgery remains the only option; however it is still a challenging (1). Patients survive following medical management have poor outcome, so, its result is disappointing (2). Primary percutaneous coronary intervention (PCI) can be reduced VSR incidence. Medical treatment has high mortality, and early surgery is recommended to prevent hemodynamic deterioration. However, surgery also associated to a high of mortality rate (3). Transcatheter device closure is an option in critical cases (4).

Ventricular septal rupture with ventricular septal dissection and coronary artery fistula after acute myocardial infarction.

Ventricular septal rupture with ventricular septal dissection and coronary artery fistula after acute myocardial infarction.

Long-Term Survival and Risk Factors for Post-Infarction Ventricular Septal Rupture

This study was performed to assess long-term survival and identify risk factors for acute myocardial infarction in patients complicated with ventricular septal rupture (VSR). A retrospective analysis of 116 patients with post-infarction VSR (PI-VSR) hospitalised in Beijing Anzhen Hospital from January 2008 to February 2019 was performed. The independent risk factors for in-hospital mortality were assessed using multivariate analysis with a logistic regression model. The Kaplan-Meier method and log-rank test were carried out for long-term survival in the surgery group. The overall in-hospital mortality rate was 47.4%. Logistic regression analysis revealed that age (p<0.05), female sex (p<0.05), no surgical repair (p<0.05), liver dysfunction (p<0.05), high heart rate (p<0.05), and low platelet count (PLT; p<0.05) were independent risk factors for in-hospital mortality. The 1-year mortality rate was lower in the surgery group than in the medical treatment group (18.3% vs 84.5%; p<0.005). During the mean follow-up of 5.2±5.1 years (median, 1.3 years), the actuarial survival rates of these patients at 5 and 10 years were 72.3% and 43.2%, respectively. The overall in-hospital mortality rate remained high. The independent risk factors for in-hospital mortality associated with PI-VSR were age, female sex, no surgical repair, liver dysfunction, tachycardia, and low PLT level. The 1-year mortality and long-term outcomes of patients treated with surgery were significantly better than those of patients who were treated conservatively.

Ventricular Septal Rupture after Acute Myocardial Infarction : Development of the Extended Sandwich Patch Repair

心室中隔破裂VSRは，急性心筋梗塞後の致死的な合併症である．発症時期は，STEMI発症後第一病日と第三から第五病日の間の二峰性にピークがある．経皮的VSR閉鎖術は，適応は限られ外科的VSR閉鎖術が根治治療である．VSR外科的閉鎖術の変遷は，1957年Cooleyの報告以来，さまざまな術式が登場し普及したが，近年でも全手術死亡42.9%，STEMI発症一週間以内の症例では54.1%であった．また，後壁型VSRの成績は前壁型VSRより成績不良であった．これらの問題解決のために，経右室切開拡大サンドイッチ法は開発された．左前下行枝または右冠動脈後下行枝の近傍を平行に右室切開し，欠損部を同定し壊死心筋を一部切除して左室内へ達する．6 cm径のパッチにあらかじめ大きな針8針ほどマットレスをかけ，辺縁から遠く放射状に左室の外の中隔と自由壁へ針を抜く．自由壁外は大きなフェルトプレジェットを，右室側に抜いた針は左室側と同様のパッチを通して中隔を挟む．最後の糸を結ぶ前に穿孔とデブリでできた欠損部に糊を入れて閉鎖する．この術式は超急性期で短絡再発が少なく高い救命率が報告された．STEMI発症後急性期であっても後壁型VSRでも手術は重度心不全の進行する前に速やかに行うことが重要である．

Percutaneous Closure of Post-infarction and Iatrogenic Ventricular Septal Ruptures Using Amplatzer Occluder®: A Systematic Review.

Ventricular septal rupture (VSR) is a rare complication of myocardial infarction (MI), open heart surgery, and cardiac-based procedures, such as septal myectomy and valve replacement. VSR is associated with high mortality rates and the reported 30-day survival rate is less than 10% without any interventional therapy. Hence, prompt diagnosis and aggressive medical treatment with appropriate surgical intervention are necessary to improve survival. Immediate surgical intervention which is the standard treatment of VSR has a mortality rate of 19-60%. Due to persistent high mortality rate and challenging management of VSR, alternatives to surgical repair has been proposed; transcatheter approach as a new alternative method has been used for the closure of post-surgery residual defects or as a bridge to surgery and in some cases as a definitive therapy instead of surgical repair. Amplatzer Occluder® (AO), a type of transcatheter closure devices, is an approved method of repairing congenital atrial septal defects and it is being used as an alternative method of treatment in VSR. In this systemic review, we assessed the cases of VSR who underwent septal repair by using AO. The study shows that the total mortality rate of percutaneous VSR repair with AO is 20% which is comparable to 19-60% rate of death in patients who undergo surgery. While early intervention is necessary to prevent biventricular dysfunction, immediate surgical intervention on soft and friable tissue surrounding the infarction increases the risk of residual shunt and reoperation. However, this study reveals that the mortality rate of primary percutaneous VSR closure within 7 days of VSR detection was 37 % which is significantly lower than 60% in surgical repair in the same period. In conclusion, given that the prevalence of residual leak in both interventions are similar and close to 20%, percutaneous VSR closure with AO device could be superior to the surgical repair as a primary intervention in unstable or high-risk surgical patients.

Mid-Cavity Variant Takotsubo Cardiomyopathy Complicated by Ventricular Septal Rupture: Case Report and Review of the Literature

Takotsubo, or stress-related, cardiomyopathy often presents similarly to an acute coronary syndrome with chest pain, ischaemic changes on ECG and a serum troponin rise. Whilst complications such as ventricular free-wall and septal rupture following acute myocardial infarction are well-recognised in the literature, similar mechanical complications following takotsubo cardiomyopathy are rare and not well-characterised.

Current concepts in the management of acute st-elevation myocardial infarction with ventricular septal rupture – Early versus late approach: Part 2 – Surgical management of ventricular septal rupture

Ventricular septal rupture (VSR) is an uncommon complication of Acute ST-Elevation myocardial infarction (STEMI) with poor prognosis. Mortality of patients with cardiogenic shock due to VSR is as high as 67% within 48 hrs and 100% within 30 days. Surgical closure of VSR a challenging procedure with mortality between 20% to 87% depending upon operator's experience and surgical facilities with backup system. In view of the poor prognosis of VSR patients and the ben¬efits from VSR closure, transcatheter closure or surgical repair of the VSR in the acute phase is usually the only option in order to stabilise haemodynamics and restore cardiac function for those with unstable hemodynamic status, despite high risk and mortal¬ity in both therapeutic operations.

Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction.

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI).MethodsA total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization.ResultsPatients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P = 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001).ConclusionNLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.

Successful Treatment of Post-Myocardial Infarction Ventricular Septal Rupture.

Successful Treatment of Post-Myocardial Infarction Ventricular Septal Rupture.

Hybrid Repair of Two Consecutive Acute Ventricular Septal Ruptures after Evolving Myocardial Infarction: Case Report

Background: Acute Ventricular septal rupture is one of dreadful complications of acute evolving myocardial infarction. Despite urgent management is lifesaving, it is still challenging and has a high risk of mortality particularly if recurrent or residual defects occurred. Evolving of skillfulness in transcatheter intervention of heart diseases paved the way for successful hybrid management of challenging cardiac cases specially for residual complicated cases post cardiac surgery. Case Presentation: We described here a successful hybrid two stage technique (surgical then transcatheter approach) to close two consecutive acute ventricular septal ruptures in 75 years old female presented with cardiogenic shock post evolving myocardial infarction. Conclusion: Hybrid repair by surgical and transcatheter interventions may be a good therapeutic modality for acute septal ruptures specially for residual or new defects after initial closure.

COVID-19 Collateral Damage–A Case of Ventricular Septal Rupture

A 73-year-old male, who had delayed presentation due to concerns regarding COVID-19, presented to the emergency department with three days of persistent chest pain. Electrocardiography demonstrated an inferior ST elevation myocardial infarction. Physical examination revealed a pansystolic murmur at the left sternal edge and apex with absence of a thrill and no evidence of cardiac failure.